CTLA-4 and PD-1 Ligand Gene Expression in Epithelial Thyroid Cancers

The dysregulation of PD-1 ligands (PD-L1 and PD-L2) and CTLA-4 ligands (CD80 and CD86) represents a tumor strategy to escape the immune surveillance. Here, the expression of PD-L1, PD-L2, CD80, and CD86 was evaluated at the mRNA level in 94 patients affected by papillary thyroid carcinoma (PTC) and 11 patients affected by anaplastic thyroid carcinoma (ATC). Variations in the mRNAs in PTC patients were then correlated with clinicopathological features. The expression of all genes was deregulated in PTC and ATC tissues compared to normal tissues. In particular, the downregulation of CD80 was observed above all in ATC. In addition, the increased expression of CD80 associated with longer disease-free survival in PTC. Higher expression of PD-L1 associated with the classical histological variant and with the presence of BRAFV600E mutation in PTC. The increased PD-L2 expression correlated with BRAFV600E mutation and lymph node metastasis, while its lower expression correlated with the follicular PTC variant. The latter was also associated with the CD80 downregulation, which was also related to the absence of lymph node metastasis. In conclusion, we documented the overall dysregulation of PD-1 and CTLA-4 ligands in PTC and ATC tissues and a possible prognostic value for CD80 gene expression in PTC

Manuale di Endocrinologia

Il manuale, utilizzando un linguaggio accessibile anche ai non esperti della materia, ma scientificamente inappuntabile, cerca di andare oltre la nozionistica tradizionale, approfondendo le moderne ed affascinanti acquisizioni di genetica e di fisiopatologia delle ghiandole endocrine ed indicando i protocolli diagnostici e terapeutici più scientificamente corretti

Resection vs radiofrequency ablation for HCC from 3 to 5 cm: A single centre experience on 101 child- pugh class A-B naive patients

Background: The optimal therapy for HCC seems to be transplantation. For all those patients not eligible for transplantation (or waiting for it) the treatment of choice has been restricted in the last years to resection (RES) or radiofrequency ablation (RFA). RFA is supposed to lose part of its efficacy for HCC ranging over 3 cm. ltuly S108 POSTERS Aim of this study is to compare RFA to RES in a restricted cohort of patients with a first diagnosis of single HCC ranging from 3 to 5 cm and with not end stage liver disease. Patients and Methods: 10 I patients never treated before were enrolled. Those patients whose HCC position required too parenchimal lost at RES (central or close to main vascular structures) were treated with RFA (60), others underwent RES (41). The two groups were similar for HCC size (mean RES:RFA = 40:36 mm) and liver disease status. The outcome was considered in terms of overall survival (O.S.) and disease free survival (DFS) calculated with Kaplan-Meier method. Differences among groups were validated by Log-rank test. Results: O.S.% in RESIRFA at I, 2, 3, 4, 5 years: 91/96, 72177, 55153, 45135,42130. DFS% in RESIRFA at I, 2, 3, 4, 5 years: 76167,44142, 3511 8, 18113, 1510. Even if RES group seems to present a better long term O.S. and DFS this difference does not reach a statistical significance. Patients with worse Child-Pugh score (B vs A) and patients that have a recurrence within the first 12 month after treatment show a worse long term survival. Conclusion: It seems that Resection and RFA have the same efficacy in treating HCC ranging from 3 to 5 cm. Survival may be mostly related to nature of HCC itself and to liver disease on the background. A larger sample size is required to confirm this observation

Incidental thyroid carcinomas. A retrospective study

The aim of the present study is to report our series of incidental thyroid carcinomas in the last 15 years and their follow-up, discussing therapeutics indications and surgical choices

Clinical implications of left ovarian vein incomplete duplicity with embryonic intersubcardinal anastomosis-derived branches

During the dissection of a female human cadaver a case of a duplex ovarian vein was observed. It was unique in its upper course where it anastomosed with an inferior polar renal vein, which in turn was linked to an upper polar renal vein by means of a joining branch. It is hypothesised that this represent a persistent link between the left subcardinal vein and the left sacrocardinal vein, together with some branches of a venous net, which represent the embryological intersubcardinal anastomosis. The gonadal vein arises from the distal (or postrenal) left subcardinal vein portion; the left renal vein develops from the intersubcardinal anastomosis. The venous net derived from the intersubcardinal anastomosis may represent a bypass system in cases of left renal vein occlusion. Left gonadal vein duplicity may also play an important role in the anatomical basis of idiopathic left ovarian vein syndrome or left varicocele, and can lead to mistakes being made during venous sclerotherapy

Clinical implications of left ovarian vein incomplete duplicity with embryonic intersubcardinal anastomosis-derived branches

IF.0.314 Surger

Fine needle aspiration cytology of 650 thyroid nodules operated for multinodular goiter: A cyto-histological correlation based on the new Italian cytological classification (Siapec 2014)

The new Italian cytological classification (SIAPEC 2014) of thyroid nodules, in line with those of Bethesda and BTA-RCPath, replaces the previous TIR3 class with two new classes (TIR3A and TIR3B), which correspond to different risks of malignancy and clinical actions required. The present study was conducted to evaluate the diagnostic accuracy of the new SIAPEC classification as opposed to its previous version (SIAPEC 2007). Preoperative cytology was compared with the final histology obtained from 650 consecutive patients who underwent total thyroidectomy for multinodular goiter. Of this total, 434 patients (group A) had their cytological diagnosis based on the old SIAPEC 2007 classification and 216 patients (group B) had their cytological diagnosis based on the SIAPEC 2014 classification. In group A 111 patients (25.6%) had a TIR3 diagnosis, while in group B 52 patients (24.1%) received a TIR3 diagnosis, of whom 30 had TIR3A and 22 had TIR3B. In group A, 46 (41.4%) out of the 111 patients with TIR3 diagnosis had, based on histology, a thyroid carcinoma. In group B, only 2 (6.7%) out of 30 patients with TIR3A diagnosis had a thyroid carcinoma. This rate of malignancy was significantly lower (p less than 0.001) than that observed in patients with TIR3B diagnosis, in which 12 (54.5%) out of 22 patients had a carcinoma. The observations here reported show that, in respect to the previous version, the new Italian cytological classification provides greater diagnostic accuracy for detecting thyroid nodule malignancy.The new Italian cytological classification (SIAPEC 2014) of thyroid nodules, in line with those of Bethesda and BTA-RCPath, replaces the previous TIR3 class with two new classes (TIR3A and TIR3B), which correspond to different risks of malignancy and clinical actions required. The present study was conducted to evaluate the diagnostic accuracy of the new SIAPEC classification as opposed to its previous version (SIAPEC 2007). Preoperative cytology was compared with the final histology obtained from 650 consecutive patients who underwent total thyroidectomy for multinodular goiter. Of this total, 434 patients (group A) had their cytological diagnosis based on the old SIAPEC 2007 classification and 216 patients (group B) had their cytological diagnosis based on the SIAPEC 2014 classification. In group A 111 patients (25.6%) had a TIR3 diagnosis, while in group B 52 patients (24.1%) received a TIR3 diagnosis, of whom 30 had TIR3A and 22 had TIR3B. In group A, 46 (41.4%) out of the 111 patients with TIR3 diagnosis had, based on histology, a thyroid carcinoma. In group B, only 2 (6.7%) out of 30 patients with TIR3A diagnosis had a thyroid carcinoma. This rate of malignancy was significantly lower (p<0.001) than that observed in patients with TIR3B diagnosis, in which 12 (54.5%) out of 22 patients had a carcinoma. The observations here reported show that, in respect to the previous version, the new Italian cytological classification provides greater diagnostic accuracy for detecting thyroid nodule malignancy

Transoral video assisted thyroidectomy. A systematic review

Abstract Introduction: The aim of this study is to perform a review of the English-language international literature concerning thyroid surgery performed through the transoral vestibular approach, to evaluate its feasibility and safety in terms of complications. Method: The review was carried out on 17 studies of 17 different authors. The following variables were taken into consideration: first author's name, nationality, year of publication, number of cases, hospital stay, conversion rate, type of surgical approach, total number of total thyroidectomies and loboisthmectomies, operative time range, intraoperative blood loss range, number and percentage of complications. Results: 736 procedures were performed: 289 total thyroidectomies and 447 loboisthmectomies. Surgical approach was trivestibular in 15 cases and combined (oro-vestibular) in 2 cases. The operative time varies from 43 minutes for a loboisthmectomy to 345 for a total thyroidectomy. Intraoperative blood loss ranges from 3 to 300 ml. Ten cases were converted into open surgery. The hospital stay varies from 1 to 10 days. Complications were: transient recurrent laryngeal nerve palsy in 34 cases, permanent in 2 cases; transient hypoparathyroidism in 62 cases. One case of postoperative bleeding, 22 postoperative seroma, 20 cases of mental nerve injury, 8 cases of operative wound infection. Conclusions: Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a new surgical method, the use of which exclusively meets the aesthetic needs of some patients. Its specific complication is the injury of the mental nerves. Further studies, however, seem to be necessary, on numerically broader cases, to ascertain the real validity of the method